Bristol Royal Infirmary 1984-1995 Public Inquiry

Bristol Royal Infirmary 1984-1995 Public Inquiry Thilini Nisansala Egoda Kapuralalage 1. Introduction A public inquiry is a review of an event or events that is conducted by the government body to find out what went wrong. Moreover, â€Å"an inquiry is a retrospective examination of events or circumstances, specially established to find out what happened, understand why, and learn from the experiences of all those involved† (Walshe, 2003). Bristol Royal Infirmary (BRI) inquiry is an example of inquiry which The inquiry is related to two teaching hospitals; the Bristol Royal Infirmary (BRI) and the Bristol Royal Hospital for Sick Children (BRHSC) and particularly the inquiry is related to congenital heart disease; babies with heart problems. The inquiry was carried out by a panel which was chaired by Professor Ian Kennedy from October 1998 to July 2001. 2. A summary of key information 2.1. Background information The National Health Service, in 1984, designated the Bristol Royal Infirmary and the Bristol Royal Hospital for Sick Children as a centre to provide paediatric cardiac surgeries to the infants under 1 year old. The Bristol Royal Infirmary performed open-heart surgeries while the Bristol Hospital for Sick Children performed closed-heart surgeries. Compared to other paediatric units in UK, Bristol did not have the required standard to perform the surgery. However, the decision to designate a paediatric unit in Bristol mainly made due to geographic issues that the patients had to undergo (Weick Sutcliffe). 2.2. Physical setting Physical setting of the hospital and operation theatre play a pivotal part in the inquiry. The location of BRI is noteworthy and it is located two block away from the BHC. Bristol Royal Infirmary conduct open heart surgeries in their hospital, while Bristol Hospital for Sick Children conduct closed heart operations in their hospital. Although the BRI conduct open heart surgeries, they lack cardiologists and they are in the BHC (Weick Sutcliffe). The operation theatre and ICU of BRI are located in two different floors. The ICU can access through an elevator and the elevator is non-dedicated. After conducting the surgery, the children are moved to sixth floor until they are stabilized. Then they are moved to BHC for further care and treatments (Weick Sutcliffe). 2.3. Administration and staff The CEO, Dr John Roylance directed the regional health authority and hospital board. Simply, these two parties relied on Dr John Roylance. On the other hand, Dr John Roylance relied on Dr James Wisheart who was â€Å"a man of many trades, holding other positions in BRI such as associate director of cardiac surgery and the chairman of the hospital’s medical committee† (Weick Sutcliffe). Furthermore, his patients were already on bypass before his arrival as he was normally late to his surgeries. In addition, Dr Janardan Dhasmana was another surgeon who was â€Å"described as self-critical, disengaged from his surgical team, and unaware of their importance as a â€Å"whole team. (Weick Sutcliffe). 2.4. Performance According to the experts, to maintain required expertise in the surgeries in a centre averagely 80-100 open heart surgeries should be conducted per year. But, the average case load of Bristol was lower than the minimal required cases. In addition, the performance of Bristol did not improve, while the performance of the all other centres began to improve. â€Å"Between 1988 and 1994, the mortality rate at Bristol for open-heart surgery in children under one was roughly double the rate of any other centre in England in five of the seven years. The mortality rate (defined as deaths within 30 days of surgery) between 1984 and 1989 for open-heart surgery under 1 at Bristol was 32.2% and the average rate for the other centres for the same period was 21.2%† (Weick Sutcliffe). Furthermore, the mortality rate increased up to 37.5% by the end of 1990. Also, according to the data analysis from 1990 to 1995, Bristol had approximately 30 and 35 excess deaths (Weick Sutcliffe). 3. Information about the issue 3.1. What happened? 3.2. How it happened? The series of incidents happened because of several reasons. First is the poor organisation of BRI. Open-heart surgery service had been provided in two sites where they lacked the proper staff to maintain the required care and treatment to the patients. Second is the lack of physical resources. The BRI was doing only the surgery and later they transferred the children into the BCH for further treatment. This cause to another issue of poor team work where the staff was not involved in the surgery and treatments effectively. Also, the BRI was using the same ICU for both adults and children. Third is the lack of information sharing with the parents and they were unaware of the relevant information (Hindle, Braithwaite, Travaglia, Iedema, 2006). 3.3. Who was involved? Few key figures were involved in the issue and they were Dr John Roylance, Dr James Wisheart, and Dr Janardan Dhasmana. First, Dr John Roylance was the CEO of the hospital but he had mentioned that he was unable to interfere with the work that were done by the surgeons. Moreover, he â€Å"chose to ignore warnings from whistle blower Steve Bolsin about the standard of operations being offered to young children† (BBC, 2003). Second, Dr James Wisheart was the director of the BRI and he claimed in an interview with BBC Radio 4’s that â€Å"the babies who died suffered from serious conditions and most had additional complications. He believed he would be vindicated in time† (BBC). Third person who was involved in Bristol was Dr Janardan Dhasmana and he was number two to Dr James Wisheart. He was responsible for over 29 deaths. Also, four babies were left brain damaged after the surgeries (Woods, 1998). 3.4. Reasons to failure There are several factors that caused the failure of surgeries at BRI. First is the poor team work which affects the performance of the work and final outcome. Effective team work plays a pivotal factor to succeed the surgery but it was absent at BRI. Second reason to failure is lack of openness. The system and culture of BRI was different and they did not encourage their staff to share their issues openly. â€Å"Those who tried to raise concerns found it hard to have their voice heard† (Kennedy, 2001). Third is the lack of human resources. There was a significant gap between the resources available at BRI and the required resources in the PCS unit. There were a shortage of staff from operating theatre and ICU. Furthermore, â€Å"the complement of cardiologists and surgeons was always below the level deemed appropriate by the relevant professional bodies. The consultant cardiologists lacked junior support† (Kennedy, 2001). Fourth is the lack of physical resources. The B RI and the BCH were located in two different places. The BRI conducted the surgeries and after that, the patients were transferred to the BCH for further treatment and care. In addition, the ICU at BRI was not properly organised and it was a mixed unit that cared for both adults and children (Kennedy, 2001). 3.4. Who discovered the problem? The performance of pediatric cardiac unit began to concern in early October of 1986 by a professor of the University of Wales. He reported to the Regional Health Authority about the unit’s performance and the authority concluded that the problem was related to the volume of cases. In addition, Dr Stephen Bolsin, a consultant anesthetist who joined the Bristol hospital in 1988, found few issues with the performances. What he noted was that surgeries done in BRI took a long time than usual and the babies were kept under the by-pass machine for a long time (Weick Sutcliffe). Apart from Bolsin’s complain to the colleagues, he reported this issue to Dr John Roylance, the CEO. But Bolsin did not receive positive reaction from the CEO about the issue. Moreover, a Pediatric Pathologist at Bristol wrote an article to report about the â€Å"post-mortem examinations of seventy-six Bristol children who had under gone surgery for congenital heart disease† (Weick Sutcliffe). In 1989, the article was publish in the Journal of Clinical Pathology. According to the article, â€Å"29 cases of cardiac anomalies and surgical flaws that contributed to death† (Weick Sutcliffe). Furthermore, several articles that criticised about the Bristol Paediatric were published in Private Eye (Weick Sutcliffe). 3.5. Why did it go undetected for the period of time? 4. Recommendations 4.1. Patient-centered health service Patients should be informed about the care that they are going to undergo. Several methods can be adhered to provide information to the patients. With relevant to the inquiry, it is evident that there were certain occasions that the communication between the staff and the parents was poor. During the treatments, some parents were given counselling, while some were not. However, â€Å"the United Bristol Healthcare Trust (UBHT) conceded in its evidence that the service it provided was insufficient to meet the needs of some parents† (Kennedy, 2001). Therefore, a good communication is required and the doctors should not judge what information should to be informed. It is parents who should make that decision (Hindle et al., 2006). 4.2. Safety and quality A safe and quality environment should be created to the patients. In Bristol, the arrangements, the state of equipment and buildings, and the training of the staff did not meet the required standard and these things were possible to create a damage to the service. To mitigate this, the authorities should remove the barriers to a safe and quality service while promoting the openness and publishing required standard of quality and care (Hindle et al., 2006; Kennedy, 2001). 4.3. Healthcare professionals’ competence Health service providers should possess the required standard of skills, expertise, and educational level. Furthermore, they are capable of good communication and team work. In Bristol, the system did not demand the professionals to keep their skills and knowledge up to date. 6. References BBC. Im not perfect, says Bristol surgeon Retrieved from http://news.bbc.co.uk/2/hi/health/568511.stm BBC. (2003). The Bristol Babies Inquiry Retrieved from http://news.bbc.co.uk/2/hi/health/1148390.stm Hindle, D., Braithwaite, J., Travaglia, J., Iedema, R. (2006). A comparative analysis of eight Inquiries in six countries. Kennedy, I. (2001). The report of the public inquiry into childrens heart surgery at the Bristol Royal Infirmary 1984-1995: learning from Bristol. Walshe, K. (2003). INQUIRIES: LEARNING FROM FAILURE IN THE NHS? : Weick, K. E., Sutcliffe, K. M. Hospitals as Cultures of Entrapment: A RE-ANALYSIS OF THE BRISTOL ROYAL INFIRMARY. Woods, M. (1998). Bristol heart scandal surgeon is dismissed Retrieved from http://www.independent.co.uk/news/bristol-heart-scandal-surgeon-is-dismissed-1197097.html pg. 1

Unipolarism

Unipolar is a system with only a single major actor, which is usually a single state that dominates all the other smaller states in the global political system. In other words to discuss the idea of Unipolar in the contemporary International system, I would briefly trace the advert of modern International system in the view of polarization. The advert of the modern international system could be traced back to the peace of Westphalia in 1648, which signify the end of the 30 years war in Europe.This treaty established the state as the main actor in the global politics and declared that the sovereign leader of each nation – state could do as she/he wished within the border’s. During this period many great powers existed in Europe, this is a system refer to as Multipolar. Multipolar is a system, with multiple power centers. By the late 19th century. The system has changed for multi – polar to what some scholars refer to as a tight Bipolar system, in which the power i n Europe allied in two rival groups before the 1st World War, which is the triple alliance and the triple entente.By the end of the 1st World War, the tight Bi- polar system has weakened. Before the beginning of 2nd World War the world has become polarized again into another tight Bi –polar consisting of the allied and axis power. Immediately after the 2nd world war, a brief Unipolar system emerged, where United States of America was the only power in Europe with the Nuclear Power, and other European Power were very weak because of the devastation of the war. But this was short lived, because the system became Bipolar with US and USSR has the two superpower power with Nuclear weapons.This period was refer to as the Cold War Era. With the fall of USSR and the end to the Cold War, clearly the Bipolar system is gone. What is not certain is how to characterized the current, still evolving system. Some scholars argued that we are in a Unipolar system because only one super power r emain, while some scholars argued or labelled the new international system as Multipolar pointing out to the increasing economic power of some European and Asian States.To some extent both terms are  accurate, the US has the world’s powerful military, which supports the Unipolar view, but the US economy is not as powerful, relative to the rest of the world , lending credence to the Multipolar view. The new system is then referred to as Multipolar or Unipolar, depending on which side of the argument scholars favour. This is argument in the early post Cold War Era. To describe the contemporary system as a Unipolar or Multipolar system is a bit unreasonable because the contemporary international system is a bit of both.The contemporary international system cannot appropriately be described a Unipolar, since that suggest the existence of one single dominant power and many small powers, and there are of course a number of â€Å"major power† in contemporary world politics such as Russia, China, Japan and the European Union, together with a number of smaller but no less important regional powers, such as India, Brazil and South Africa. Nor can the system be describe as Multipolar for the gap between the United States and the various major powers is simply too large. Unlike a true Mutipolar system, where there are a number of comparably sized powers.The present system features a single power seeking hegemony over all other, and a number of major powers which have the desire to resist the hegemonic impulses of the United States, but neither the strength nor the desire to challenge the United States directly and a large number of small powers. While the US would clearly prefer a Unipolar system in which it would be the hegemony, major power on the other hand would prefer a multipolar system. With my research, and in relations with situation of events in the global system I would say we are far from being in a Unipolar system and what we have presently is a Multipolar system.Thou we have US has the hegemony. The future configuration of world powers is difficult, beyond the safe bet prediction that US hegemony like that of every other great power in history, will end. In conclusion therefore, I would say that what we have presently in the international system is definitely not a Unipolar system. It could therefore be called a mulltipolar system, but a proper Multipolar system will evolve when the United States becomes an â€Å"ordinary major Power†.

Global Perspectives Essay

1. Globalization can be demonstrates a way towards a well-developed economy, cultural, political and technological interdependence through the national institution and economics. As countries reduce barriers to trade and investment, globalization force their industries to grow more competitive if they want to survive. Globalization is different from internationalization but it is characterized by denationalization. When the internationalization is higher in a country it can import and exports good, services, money and people across the national borders of the company. 2. Globalization of markets can be demonstrated as covering buyer preferences in markets around the world. This method covers in many products such as consumer goods, industrial products and business services. The globalization of markets is important to international business because it offers some benefits for these companies. There are few benefits have been described in follow. * Firstly it reduces marketing costs. This has mainly focused on companies which sell Global products, it can reduce the cost by standardizing their certain market activities. * Another benefit is it creates new market opportunities, because of this a global product can explore opportunities abroad if the home market is small or becomes saturated. * Levels uneven income streams, Accompany which sell their products all over the world, but seasonal appeal can use international sales to level its income stream. 3. Technology speed up the globalization process by introducing new technological aspects to the society. It ease the people to communicate with in the country and make and effect toward the globalization. Introducing new technological instruments encourage the community to use the new aspects and survive the need of the society. Introducing new technology low the barriers of the culture in a country it encourage the community to explore the world as it knows as globalization. As an example wireless internet connection has changed the world. Anyone can explore the world by their smart phone tablet etc. that speed us toward globalization of the country. Task 2 * I interviewed a security officer. His age is 43 and he got this job when he is 21. He has been given his service to the company for 22 years. * Before 22 years ago he had to travel 2 hours towards his working place because the condition of the train system is different from present. * In his working place 20 years ago if an employee, employer or a customer entered to the office this security officer had to check his bag manually by opening all the pockets of the bag, he had to check his all the belongings and he had check his clothes. * Then he had to write down the name and the Id number of the person. But in present these whole process is done by machinery. * Now this security officer has to look at the computer screen in his office computer and check all these things. * If there is anything suspicious the computer will identify it immediately. * Then he has to type the ID number of the person in the computer all the detail will come to the screen with in few seconds. * This demonstrates the way how technological improvements have changed the way the security officer work compared with 22years ago.

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